Applying the transtheoretical model to promote greater fruit and vegetable consumption: a successful approach to maintaining behavioral change

The purpose of this study was to investigate the response of participants in the first three Stages of Change (SOC) to a preparation stage-tailored intervention to increase fruit and vegetable (F&V) consumption. An on-line survey was delivered to 400 university employees, and included questionnaires about their demographic information, SOC, self efficacy (SE), and decisional balance (DB). One hundred fifty six (39%) responded to the survey. A total of 40 were selected from the first three stages, precontemplation (PC), contemplation (C), and preparation (P), and were assigned into two groups (PC/C and P) with consideration to the best possible matching in age, gender, income, education, and smoking status. Employees in both groups received the same intervention which was composed of four 1-hour sessions given over four consecutive weeks. Outcomes (F&V, SOC, SE, and DB) were measured at every session, and were also measured at weeks 5, 6, and 20 following the intervention. At baseline (the response to the survey), the majority of the 400 employees were in the contemplation and the maintenance stages (34.9 and 34.3% respectively). Most of them reported positive perception and self confidence of consuming 5 servings of F&V everyday. Employees who were greater than 50 years old and held a PhD degree were more likely to consume five servings of F&V every day. During the intervention and until week 5, all employees increased their F&V, SE and DB and moved an advanced along SOC. However, employees in the PC/C group failed to maintain the change after week 5, and relapsed back to the baseline measures. The repeated measure MANOVA revealed a statistically significant interaction between the intervention and time which suggests that the intervention had a different effect on the employees in the two groups (i.e., relapse for the PC/C group and maintenance of the P group). These results suggest that individuals who receive intervention not matching their SOC are at higher risk to relapse. Stage-tailored interventions may be more cost-effective when delivered to the appropriate individuals

Women's Health and Well-Being in the United Nations Sustainable Development Goals: A Narrative Review of Achievements and Gaps in the Gulf States.

In 2014, United Nations member states proposed a set of sustainable development goals (SDGs) to help further the millennium development goals that they had proposed in New York in 2000. Of these 13 SDGs, Goal 3 (i.e., SDG 3) was titled "Good Health and Well-Being." This goal highlighted women's health and well-being via two key objectives. The first, SDG 3.1, aimed to reduce maternal mortality rates (MMR) and the second, SDG 3.7, aimed to ensure access to sexual and reproductive health care services. Drawing on all the latest reports, which have been released by Gulf Cooperation Council states (GCC), this paper sheds light on GCC states' work on women's wellbeing through SDG 3. the paper aims to review GCC states' work on women's wellbeing in SDG3, which achievements they obtained, which tools they used and which gaps still exist. The paper aims to explain the socio-cultural background behind these achievements, tools, and gaps. For the purpose of this study, we used narrative review approach through which we reviewed reports from 2017 and 2018 on SDGs published online by the Ministry of Development and Planning of each GCC state, and latest reports of the WHO on the same states. the study found similarities and differences between different GCC states, which in turn reveals gaps and areas that are not meeting women's needs. The findings show that MMR in GCC countries has declined by nearly half. The main strategies they adopted to address SDG 3.1 included awareness campaigns, improving access to healthcare systems and training professionals. The tools used to meet SDG 3.7 included training health professionals and raising awareness of consanguinity. The study reveals several gaps, such as a lack of discussion around challenges and barriers, and a lack of linkage between an SDG and the targets contained within it. The paper concludes that there is a much greater emphasis on reducing MMR, compared to providing access to sexual and reproductive healthcare. This difference is due to different socio-cultural framing of each of these two issues

Uncontrolled Glycemia and High Percentage of Truncal Fat Elevate Levels of CRP and IL-6 Among Patients with Type 2 Diabetes

Background Systemic inflammation is the continuous phenomenon of inflammatory response which can promote tissue damage. Systemic inflammation is characterized by circulatory elevation of many inflammatory mediators such as (CRP, IL-6 and TNF-α). This state plays a pivotal role in all stages of type 2 diabetes. Stages include pathogenicity and progression and chronic complication development. This study aimed at investigating the risk of systemic inflammation among type 2 diabetic patients according to glycemic control. Objectives This work aimed to investigate the risk of systemic inflammation among type 2 diabetic patients in relation to body fat accumulation and distribution among patients with controlled glycaemia versus poorly controlled patients. Subjects/Methods Study protocol and tools were approved by the research ethics committee; Institutional Review Board (IRB) at Jordan University of Science and Technology (JUST). Patients were recruited from out-patient endocrinology unit at King Abdullah University Hospital (KAUH), Jordan University of Science and Technology Health Center and major private endocrinology clinics in North of Jordan. Initial screening included 1500 patients diagnosed with type 2 diabetes. Due to the multiple co-variation nature of the relationship of interest, about 75% of the initially screened patients were excluded from the study. A total of 198 male and female patients diagnosed with type 2 diabetes participated in this cross-sectional. Patients’ weight, height, waist circumference, total body fat and truncal fat percent were measured. Venous blood specimen were collected and levels of HbA1c, serum hs-CRP, serum IL-6 were determined. A 10-ml sample of venous blood was collected from each patient by a registered nurse. HbA1c blood samples collected in Ethylene-Diamine-Tetra-Acetic acid (EDTA) tubes and measured in whole blood using the Immuno-inhibition test for the quantitative determination of glycosylated hemoglobin (Beckman Coulter AU analyzers). Blood samples of hs-CRP and IL-6 collected in Z-Clot activator tubes. Samples were allowed to clot before centrifugation for 15 minutes at 1000 × g. Aliquot of serum stored at ≤ -22°C in a sterile small tubes prior to biochemical assay. Immuno-turbidimetric test was used to determine hs-CRP levels (Beckman Coulter AU analyzers). IL-6 was measured using a human immunoassay kit from R&D SYSTEMS through sandwich-type enzyme-linked immunosorbent assay (ELISA). Absorbance Microplate reader was used to measure the optical density of IL-6 (BioTek ELx800). Anthropometrics (weight, height) were measured following World Health Organization procedures. 18 Body weight was measured with the individuals wearing no shoes and light clothing. Height was measured using measuring rod (Seca, Germany).Body Mass Index (BMI) was calculated using the ratio of weight (kilograms) to the square of height (meters) kg/m2. Waist circumference (WC) was measured to the nearest centimeter using non-stretchable circumference measuring tape (SECA 203, Germany). The site of tape placing was determined according to World Health Organization (WHO) description of middle way between the iliac crest and lower rib border. The WHO BMI cutoff points were used to classify patients based on their BMI and WC. Patients’ total body fat and truncal fat percent were determined using bioelectrical impedence technique (TANITA, BC-418). The Segmental body composition analyzer (TANITA, BC-418) used in this study was previously validated against hydro-densitometry in the assessment of body composition in healthy young adults. Body fat and percentage cut-off points used were gender and age specific based on which patients were classified into healthy, over-fat, and obese. Cut-off points for truncal fat % were gender specific based according to which patients were classified into three levels of truncal fat: low, average, and high. A P-value of < 0.05 was considered the cut-off level for statistical significance. Multivariate analysis of variance (MANOVA) was used to examine the relationship between serum levels of hs-CRP, IL-6 and glycemic control and body fatness, Least Significant Difference (LSD) post-hoc MANOVA was conducted to determine the difference between patients in different categories. Results Poorly controlled females had higher levels of hs-CRP as compared to poorly controlled males (P = 0.004). However, no differences were noticed in the CRP serum levels in good glycemic control group. At the same time, older patients with poor glycemia had higher serum IL-6 levels as compared to younger patients. In poor glycemic control group and after adjusting for age, gender, lipid lowering drugs and diabetes duration, the (hs-CRP) serum levels of patients with high BMI (obese) was significantly higher than that observed in the normal, and overweight patients (P-value = 0.02). Body fat percentage was significantly associated with hs-CRP serum levels inpoor glycemic control group; patients with healthy body fat percentages had lower hs-CRP (6.30 ± 0.66) compared to patients with obese patients (11.89 ± 1.30). Trunk fat mean seems to be significantly associated with patients’ hs-CRP serum levels regardless of the glycemic control groups (P-value = 0.05). Among patients with poor glycemic control, higher levels of serum IL-6 were detected in obese patients (6.10 ± 0.93) compared to those with normal body weight patients (4.06 ± 1.82). Similar trend is found with regard to WC where patients with poor glycemic control continue to have higher levels of IL-6 with higher WC (P = 0.018). Positive relationship was found between IL-6 serum levels and trunk fat percentage among all patients regardless of glycemic control. Conclusion Findings of the current study indicate that high subcutaneous intraperitoneal fat induces the risk of systemic inflammation regardless of glycemic control. General obesity is associated with systemic inflammation only among patients with poor glycemic control. This study had several strengths including the tough selection procedure of the participants to rule out any response to acute response to inflammation. Several blood measurements were performed on the patients including HbA1c, CRP, and IL-6 which add to the validity of our hypothesis testing. Moreover, the study operationalized obesity in different ways BMI, WC, total and truncal fat%. However, findings of this study is limited due to the cross-sectional nature of the study design.qscienc

Protein intake among patients with diabetes is linked poor glycemic control

Background: Nutrition therapy is considered a key component of diabetes management. High-protein diets are recently gaining more popularity. Knowledge regarding the potential glycemic effect of protein in people with type 2 diabetes has been a particular interest. Methods: This study is a cross-sectional study based on NHANES data collected on participants aged 40 years and older who attended the surveys cohorts of 2011–2012 and 2013–2014. Data on 1058 participants were included in the analysis. Glycemic control was measured as HbA1c level and patients were categorized into quartiles of daily protein intake. Analysis adjusted for age, gender, race and energy intake muscle strength (quartile), sedentary activity, income to poverty ratio, education, smoking, alcohol drinking and BMI. Logistic regression models were produced to investigate the impact of high protein intakes on odds of poor glycemic control (HbA1c ≥ 7). Results : After controlling for muscle strength (quartile), sedentary activity, income to poverty ratio, education, smoking, alcohol drinking and BMI; patients in Quartile 4 for protein intake had 260% increased risk for poor glycemic control as compared to those in quartile 1. These results are limited because the analysis did not consider the source of protein (animal vs plant). Further studies are needed

Body Shape Index Is a Stronger Predictor of Diabetes.

Anthropometric indicators can predict the development of diabetes among adults. Among them, a new indicator (Body Shape Index) was developed. Several cohort observational studies have demonstrated that A Body Shape Index (ABSI) is a prominent indicator for mortality and morbidity. Nevertheless, the predictive level of ABSI for diabetes varied among different ethnicities. This study aimed to assess the predictive level of ABSI for diabetes compared to BMI in the Qatari population. Date from 2536 Qatari adults aged 20-79 years attending the Qatar Biobank Study were used. Body height, weight, and waist circumference were measured. Blood samples were measured for glucose. The association between ABSI, BMI, and diabetes was assessed using a logistic regression. Both ABSI and BMI were positively associated with diabetes after adjusting for potential confounding factors. ABSI had a stronger association with diabetes than BMI. Per 1 SD increment of ABSI and BMI, the z-score had an odds ratios of 1.85 (1.54-2.23) and 1.34 (1.18-1.51) for diabetes, respectively. ABSI and BMI are significantly associated with diabetes in the Qatari population. ABSI is a better predictor for the risk of diabetes than BMI after the adjustment for age, gender, education, and physical activity

The Influence of Fasting and Energy Restricting Diets on IGF-1 Levels in Humans: A Systematic Review and Meta-Analysis

Background: Fasting and energy restricting diets have a potential means of delaying or preventing the onset of a range of age-related metabolic and neoplastic diseases. Consistently at the centre of this effect appears to be a significant reduction in circulating IGF-1 levels. The aim of the current systematic review and meta-analysis was to determine the influence of fasting and energy restriction on IGF-1 levels in human subjects. Methods: A comprehensive systematic search was conducted from onset of the database to February 2019 in Embase, MEDLINE/PubMed, and SCOPUS to identify randomized clinical trials that investigating the impact of fasting or energy restriction circulating IGF-1 levels. Effect size was reported as weighted mean difference (WMD) and 95 confidence intervals (CI) using a random-effects models. Subgroup analysis was performed to identify the probable source of heterogeneity among trials. Results: Total pooling of fasting and energy restriction randomised controlled trials in WMD analysis revealed no significant effect on circulating IGF-1 levels (WMD: �16.41 ng/ml, 95 CI: �35.88, 3.07). Sub grouped analysis fasting regimens appeared to substantially reduce IGF-1 (WMD: -28.87 ng/ml, 95 CI: �43.69, �14.05, I 2 = 00), energy restricting regimens failed to do the same (WMD: -10.98 ng/ml, 95 CI: �33.08, 11.11, I 2 = 90). Within this final subgrouping, it was observed that only energy restriction regimens of 50 or greater of normal daily energy intake were capable of significantly reducing IGF-1 levels (WMD: -36.57 ng/ml, 95 CI: �59.19, �13.95, I 2 = 00). Finally, a meta regression were noted in which the percentage restriction of daily energy intake inversely correlated with plasma IGF-1 levels (p = 0.04). Conclusion: This study uncovered that fasting significantly reduced levels of IGF-1, while energy restriction diets were successful only when intake was reduced by 50 or more. © 2019 Elsevier B.V

Prevalence of Food Insecurity among Women in Northern Jordan

Food insecurity—not having sufficient quantities of good-quality foods—is inversely related to physical and mental health and directly related to poor dietary intake. The objectives of this research were to (a) measure the prevalence of food insecurity among women in northern Jordan, (b) study the socioeconomic factors associated with an increased risk of food insecurity, and (c) investigate the relationship between household food insecurity and women's reported body-weight. This cross-sectional study was conducted using an interview-based questionnaire. In total, 500 women were interviewed in the waiting rooms of the outpatient clinics of two major public hospitals in northern Jordan. Food insecurity was assessed using the short form of the U.S. food security survey module. The prevalence of food insecurity was 32.4%. Income below the poverty-line, illiteracy, unemployment, rented housing, and woman heading the household were among the socioeconomic factors that increased the probability of food insecurity. No evidence was found to support the relationship between obesity and food insecurity. Except grains, food-insecure women with hunger had lower intake of all food-groups. This study demonstrated that the problem of food insecurity is present in Jordan. Food-insecure women with hunger are at a risk of malnutrition. Interventions that target reduction of the factors associated with food insecurity are necessary

Muscle Strength and Glycaemic Control among Patients with Type 2 Diabetes.

Poor glycaemic control is associated with chronic life-threatening complications. This cross-sectional study examined whether there is an association between handgrip strength and glycaemic control among patients with diabetes. Data on 1058 participants aged 40 and older were collected from the National Health and Nutritional Examination Survey (NHANES). Muscle strength was assessed using a handgrip dynamometer, and glycaemic control was assessed using HbA1c. Handgrip strength was presented as age- and gender-specific quartiles, with participants in quartile 1 having the lowest handgrip strength and participants in quartile 4 having the highest handgrip strength. Logistic regression analyses were used to assess the association between handgrip strength and poor glycaemic control among participants with diabetes. Three models, each adjusted to include different variables, were employed. Odds ratio (OR) values revealed no association between handgrip strength and glycaemic control after adjusting for age, gender, and race in model 1. With further adjustment for sedentary activity, income-to-poverty ratio, education, and smoking, patients in quartile 4 of handgrip strength had 0.51 odds of poor glycaemic control (95% CI: 0.27-0.99). However, the reported association above vanished when further adjusted for insulin use (OR = 0.67; 95% CI: 0.35-1.28). In conclusion, findings may indicate an association between glycaemic control and muscle strength. This association may be altered by insulin use; further investigations are required.Qatar University (project No. QUST-1-CHS-2020-11

Abdominal Fat Is Directly Associated With Inflammation In PersonsWith Type-2 Diabetes Regardless Of Glycemic Control – A Jordanian Study

Background and aim: Systemic inflammation is related to the progression of complications associated with diabetes. This study aimed to investigate the association between general and abdominal obesity and inflammation in patients with type-2 diabetes with or without glycemic control. Methods: A total of 198 men (n=73) and women (n=125) diagnosed with type 2 diabetes participated in this study. General obesity markers, body mass index (BMI), and abdominal fat were assessed. Circulating concentrations of glycated hemoglobin (HbA1C), C-reactive protein (CRP), and serum interleukin-6 (IL-6) were determined. Poor glycemic control and good glycemic control were defined as having fasting HbA1C concentrations ≥7% and <7%, respectively. Multivariate adjusted analysis of covariance was used to determine the relation between BMI and abdominal fat and markers of inflammation in patients with good and poor glycemic control. Results: Patients in <7% HbA1C category, those with high abdominal fat had ≈262% higher CRP and ≈30.6% higher IL-6 compared to those with low abdominal fat (p˂0.05). Patients in ≥7% HbA1C category, those with high abdominal fat had ≈41.4% higher CRP and ≈33.9% higher IL-6 compared to those with low abdominal fat (p˂0.05). Abdominal fat was directly related to CRP (p˂0.023) and IL-6 (p˂0.002) concentrations in both groups of type-2 diabetic patients with <7% and ≥7% HbA1C. In patients with ≥7% HbA1C, BMI was directly related to CRP (p˂0.02) and IL-6 (p˂0.047). Whereas in patients with <7% HbA1C, BMI was not associated with CRP or IL-6 concentrations. Conclusion: High level of abdominal fat is associated with systemic inflammation in type-2 diabetes regardless of glycemic control. Abdominal fat is a better predictor (determinant) of inflammation than BMI in patients with type-2 diabetes with or without glycemic control. Keywords: BMI, C-reactive protein, diabetes, IL-6, inflammation, obesityThis research is funded by Jordan University of Science and Technolog

Adiposity indicators as cardiometabolic risk predictors in adults from country with high burden of obesity

Background : In Qatar more than 70% 0f the adults are overweight and obese. Different adiposity assessment methods have been proposed to identify individuals at cardio-metabolic risk. Purpose : This study aimed to compare anthropometric indicators with Dual-energy X-ray absorptiometry (DXA) –derived adiposity indicators in predicting cardio-metabolic risk among Qatari adults. Patients and methods: A random sample of five hundred and fifty-eight (558) healthy Qatari adults (men and women) aged 20 to 50 years was obtained from Qatar Biobank survey data. Anthropometric data (weight, height, and waist circumference), the DXA-derived data, and cardio-metabolic (CM) risk parameters were analyzed. A Spearman partial correlation coefficient , Receiver Operating Characteristics (ROC) curve and an area under curve (AUC) were used to assess the predicting ability of adiposity indicators for CM risk factors. Results: Adiposity indices (anthropometric and DXA) were significantly correlated with most of the CM indicators (r= -0.292 to 0.486, p< 0.001). The AUC of waist to height ratio (WHtR) was significantly higher than that of body mass index (BMI) and waist circumference (WC) in the prediction of low high density lipoprotein (HDL) (AUC=0.65, AUC=0.59; AUC=0.64), high low density lipoprotein (LDL) (AUC=0.67; AUC=0.62; AUC=0.66), high cholesterol (AUC=0.66; AUC=0.63; AUC=0.63), and high Homeostatic Model Assessment- (HOMA) (AUC= 0.81; AUC= 0.78; AUC=0.78). Among DXA- parameters, trunk fat had the highest AUCs for total cholesterol (AUC= 0.64, CI=0.56, 0.73), triglycerides and glucose index (TyG) (AUC=0.69, CI=0.64, 0.74), and HOMA (AUC=0.78, CI= 0.73, 0.84). Conclusion: Results of the present study show that adiposity indicators (WC and WHtR) are clinically valuable tools to identify individuals at risk of CVD compared to DXA–derived parameters, while DXA can provide more accurate estimates.The project was funded by Qatar University, grant number QU-2-CHS-2018-3. Article processing charges fees were handled by Qatar National Library